Questions related to Pain Medicine
The Paolo Procacci Foundation, a foundation whose aim is to increase research and developments in Pain Medicine, is trying to develop new knowledges on inflammatory pain.
Is it necessary to take a lower limit as inclusion criteria for the ODQ? The design from our low back pain study is planned as randomized, sham treatment controlled trial. I am concerned about getting a to small difference for the stats, if we don´t choose a lower limit.... Especially the between group difference...
I am a 57 year old female who is morbidly obese and have suffered three strokes on the right side. I suffer from chronic pain and numbness. Not only on my right side but my lower back as well. Are there any medications for chronic pain that work that are not narcotics? I would appreciate any information you could provide.
Kathi J Peacock
I have been searching the literature on the effective analgesic method during the reduction of simple shoulder and elbow dislocation, such as the use of intra-articular lidocaine and conscious sedation.
The literature is vast with comparative studies on intra-articular lidocaine and conscious sedation in the reduction of simple shoulder dislocations, however, I couldn’t find any comparative studies on simple elbow dislocations.
Provided that the elbow is the second most common dislocated joint in the body, Is there any scientific reason for the lack of studies on the elbow?
Treatment of osteoarthritis hip is mainly surgical.Attempts to look at treatment options and traditional medication has not been well cited or published.
Do outline treatment options seeked by your patients in dealing with hip osteoarthritic pain and its success rate
I had two patients with anal pain, probably proctalgia or anodynie with reporting of a burning or painfull sensation in the foot, mostly the sole.
Do you know of studies about the efficacy of intra articular injection of autologous fat in knee joint osteoarthritis helping in pain relief or ligament regeneration ?
The published research on Botox for Migraines generally suggests that it only works for Chronic and not Episodic Migraines.
However this is not my experience, and it does not fit with the history of how the effect was first a serendipitous discovery in people who were having Botox for their wrinkles!
I would suggest that the failure of Botox in treatine Episodic Migraines is a failure of the PREEMPT Protocol devised by Allergan. Because they were scared that injecting the corrugator muscles would cause a high incidence of lid ptosis so the existing protocol actively avoids injecting them, even though it suggests it does.
It is interesting that Silberstein/Allergan are now teaching people how to inject into the corrugators directly, though this is not yet published. Indeed one neurologist in the UK, who was shown the 'new' technique, was told that perhaps she shouldn't use it because it wasn't yet published
I use a much higher dose in the corrugators (see the articles in my project) and find it very effective in both chronic and episodic migraines
What have other people found?
Referred pain is felt at an area where the viscus was once situated in embryonic life.
egs. #1. Diaphragmatic pain is felt at shoulder region (diaphragm was situated at the root of the neck)
#2. Testicular pain is felt at abdomen (testes descended from abdomen)
#3. Renal pain is felt in loin (kidney ascended up)
Have clinicians ever come across a case where the 'antiquated' embryonic viscus referred pain hypothesis was proven wrong? Convergence and subliminal fringe theories obviously make a lot more sense.
Looking for research on short and longterm effects of trigeminal neuralgia on patients. All aspects of condition, treatment, physical course and outcome, emotional and psychological course and outcomes are of interest.
About 30% of Ethiopians are CYP2D6 ultra-rapid metabolizers. The Ethiopian Food, Medicine and Health Care Administration and Control Authority (FMHACA) said it has banned the drug codeine which is used for pain relief, in November 2015. However,codeine is still used in children and adults in this country. The ban and again,the resumption are not based on scientific evidence. To my opinion,codeine could still be a problem on such phenotype group and evidence on the safety should be deeply investigated.
I would deeply appreciate if any scientific evidence could support this .
I' ve found some articles describing how Reiki was beneficial animically as patients expressed wellbeing and could manage pain better. However, as far as I'm concerced there is no such evidence as to conclude that reiki has truly benefits or it is just a placebo.
I wonder the exercise range （begin to stop）, the angular speed of such isokinetic exercise for low back pain patients. Anyone have used this kind of exercise???
This 6 mo old girl is extremely painful, despite a morphine and amitriptyline treatment. She has an ANTRX2 mutation.
We tried oral corticosteroids without visible effect.
Does anyone have experience of oral penicillamine in this indication at this youg age ? Other medication ?
Thanks in advance for this little girl and her family.
Any EBP on acute pain teams? Who should be on the pain team besides (Anesthesiologist, CRNA, RN, Pharmacist, PT, Nurse Educator)? I am looking to implement a pain team in a small orthopedic hospital.
iv dexamethasone has been shown to decrease pain after laproscopic surgery.Can any other drug by intraperitoneal route be sufficient?
C5AR has been shown not to just be connected with inflammatory reactions, but seems to have direct actions on some brain area involved in pain perception.
There may be altered joint arthrokinematics and other mechanical issue of an adjacent structure, which may contribute to lateral knee pain. So, what will be the best physiotherapy management?
I mean, I know it depends also on the location and the type of pain (headache disorder, neuropathic pain, musculoskeletal pain).
I'm looking a basic solution (2 channel) with software to start using it both for research and clinical use.
One channel could be use for eeg and the other? (e.g. muscle tone, skin conductance/impedence, blood pressure, breathing, heart rate variability).
Sorry if that is a little bit broad question
I saw a 60 years odl women with an history of central stroke (left hemiplegia wich completely recover) and 3 months later complained of a pain in the left upper limb. Physical examination shows many painfull muscle Trigger Points (trapezius, infraspinatus, pectoralis major)
Can we make the link between the stroke and the mTrP: are they neuropathic?
Thank you and have a nice day
In our pain center we use a five days subcutaneous protocol with 100mg/24 hours.
it sometimes gives good results but also sometimes the situation remains unchanged.
Your opinion interests me, thanks.
There are more then few people who suffer continuous pain about a part of the body that exist or is missing when the injury is not there any more. This is called Complex Regional Pain Syndrome, CRPS. By researching it lately it might have been caused by the lack of swomething at the point of the injury. The body keeps radiating the pain as if the injury still there. Does someone have an experience with such pains and the cause for it or the lack of something that have caused it. This might help a lot by trying to eliminate the pain using new methods of healing for a young girl who suffers from it.
Patients have several pain scores before and after medication treatment. Would like to apply a longitudinal or time series model to compare slopes before and after and evaluate the medication effect on pain reduction.
I'm not sure whether it is justified to perform some type of normalization on the patient´s pain scale data, spliting 1-10, the smallest intensity to biggest intensity.. This is a comparison of the two groups (control a treated) before and after treatment. Researchers maybe poorly informed the patients about the rating scales so some patient´s evaluate pain with maximum values in comparison with others, despite the fact it is not a serious health problems characterised by maximum pain.
Im am doing my CTR now , and the topic is renal colic, how safe is our approach in UK, and how safe is the use of NSAID's in a pt with a potential post-renal obstructive renal injury. Thanks
It is well known that pain plays an important role in the early period of life, as it informs an individual about the danger for his health (role of protection and education). Thus, people with rare form of neuropathy, that cannot experience this sensation, are used to having a lot of traumas and other health damage even as adults. It is reasonable to suggest that a problem can come up when painkillers are taken against the pain caused by people’s bad habits (ex. excessive workload - headache, bad nutrition habits - stomachache). The long-term analgesics intake after each occurrence of pain can lead to their unawareness of the consequences of such behavior. As a result, the educational function of pain is highly perturbed. This can explain the lack of instinct of self-preservation in individuals, who voluntarily damage their health (ex. smoking).
Is there any research that has already been made on this subject? What path should I take to find more information about it? Thank you
I am looking for a validated tool that can identify muscle pain or myalgias as major predominat factor in chronic pain patients? Are there any such questionairres used in fibromyalgia research for example?
I am trying to find out level of cartilage destroying enzymes which is associated with crepitus sound with pain.
I see many anesthesia techniques can be used for kidney transplantation.
In my hospital for recipient we use lower combined epidural & intravenous anesthesia (TCI propofol). Postoperative analgesia achieved by continous ropivacaine 0.15% + fentanyl 2 mcg/mL, rate 8 mL/hr via epidural catheter for 3 days and iv paracetamol.
For laparoscopic living donor we use combined epidural & general anesthesia (volatile). Postoperative analgesia: intermittent epidural bolus (bupivacaine 0.125%, morphine 2 mg, volume 10 mL, 2x/day) + iv paracetamol.
normally we use ibuprofen and paracetamol combination or ketorol or aceclofenac. but there is difference in responce in different patients.
I want to know when, based on HIT-6 scores, a patient is clinically improving, e.g. pre- or post-treatment. I'm looking for specific data for tension-type (episodic) and cervicogenic headaches.
In European countries, outside the UK, many patients with refractory angina pain are referred to the implantation of spinal cord stimulator. We do this in our center as well. The studies have shown this method is effective in decrease of pain intensity and improvement if the quality of life (Lanza et al., Neuromodulation 2012; Borjesson, Future Cardiol 2011). But from our experience, these patients may get complicated - electrode displacement, infection, etc. We have had quite good experience within last few years with a following algorithm - 1. US guided stellate ganglion block - if the patients respond - 2. VATS thoracic sympathectomy- Any comments, ideas, experiences?
Due to continued pressures related to prescription drug abuse, the DEA and local state organizations (Boards of Pharmacy, Boards of Medicine) are considering the reclassification of Hydrocodone (and combination products such as Vicodin, Norco, etc) as a Schedule 2 medication.
I would like to start some research on whether primary care opioid prescribing for chronic non-cancer pain meets current guidelines, especially for patient safety. There are too many recommendations in our guidelines to use all of them, some are more/less important, and some are difficult to operationalize for a chart review or ongoing quality improvement. I have seen some initial work on quality/safety indicators for opioid prescribing by others in unpublished and grey literature. Does anyone know which would be the best to use, and where/how this is being measured?
I am interested in compiling evidence on various non-surgical approaches for EDS patients including; active rehabilitation, orthoses, and manual therapies, focusing more specifically on the musculoskeletal manifestations. As the literature is sparse, I was wondering if anyone has input, or know of any specialists I can try contacting. Also, if there are any trials currently being conducted or similar work being done kindly bring them to my attention! Thank you!
I'm thinking specifically about back pain but any article on the topic would be great.
Surgery would be suggested to a 61 years old women patient, but she is not accepted. The patient does not feel neurologic cladication.
I found a combination of newer generation intravenous NSAIDS (dynastat) and oral opioids (Tramadol) works for many patients, but not all. Can you share your experiences?
Is it correct that it manifests it's effects within 2-5 minutes as mentioned in this article which I am unable to access and later cited by a recent text on opioids.
Lewis, J. W. "Structure-Activity Relationships of Opioids− A Current Perspective." Proceedings of the VIIIth International Symposium on Medicinal Chemistry I. Stockholm, Sweden: Swedish Pharmaceutical Press, 1985.
What do clinicians feel about this?
I've just read two recent papers that have me musing: LAKEMEIER S, Lind M, Schultz W, Fuchs-Winkelmann S, et al. (2013) paper looks at a comparison between steroid injections and radiofrequency denervations for people with low back pain. The conclusion suggests that both procedures "...appear to be a managing option for chronic function-limiting low back pain of facet origin with favorable short- and midterm results..."; and ANDREW MOORE R. (2013) "What Works for Whom" suggesting that statistical significance is less useful than a patient-centric view of effectiveness.
My question is - if chronic back pain is a condition likely to persist, what are the effects in terms of beliefs about pain, quality of life, interference in "living well despite pain" when a person needs to keep attending clinics to have invasive treatments?
I say this after seeing people who have attended self management programmes, with the same pre-treatment pain intensity, distress, disability as those reported in Lakemeier's paper, remain well with reduced distress and disability - and more importantly from a systems perspective - less need to rely on healthcare.
How can this be measured? Has anyone carried out a head-to-head economic study of self management vs ongoing procedures? Or am I simply showing my self-management bias?
The two references:
LAKEMEIER S, Lind M, Schultz W, Fuchs-Winkelmann S, et al.
A Comparison of Intraarticular Lumbar Facet Joint Steroid Injections and Lumbar
Facet Joint Radiofrequency Denervation in the Treatment of Low Back Pain: A
Randomized, Controlled, Double-Blind Trial.
Anesth Analg. 2013.
ANDREW MOORE R.
What works for whom? Determining the efficacy and harm of treatments for pain.
Pain. 2013 Mar 15. pii: S0304-3959(13)00119-X. doi: 10.1016/j.pain.2013.
I would like to investigate the relationship between pain and Naadi (a significant parameter used to diagnose diseases in Indian medicinal procedures in Sidha, Ayurvedha and Naturopathy). Does anyone have any information on it?
Many clinical trials have demonstrated the effectiveness of gabapentin and pregabalin administration in the perioperative period as an adjunct to reduce acute postoperative pain. However, very few clinical trials have examined the use of gabapentin and pregabalin for the prevention of chronic postsurgical pain (CPSP).
In the 1980's my colleagues and I found an association between parafunctional oral habits and a diagnosis of common migraines. The last clinical paper I wrote on the subject is attached. I am considering initiating additional research in this regard, but wanted to first find out if this had been investigated further by others. I have found more recent studies on oral habits related to facial pain, but not directly related to those diagnosed with common migraine.
Least invasive pain route is well established in palliative medicine but IM injections are still common in acute managment. Specifically, I need to make a valid case to change practice of IM injections for immediate post-operative patients.
Of all the ankle ligaments present, the most commonly (85 %) involved ligament to be sprained is the Lateral ligament complex (Anterior Talofibular, Posterior Talofibular and Calcaneofibular Ligs.). Based on the severity (stable / unstable) of sprain the protocols are carried out usually. I came across this article and found it quite new that these UNSTABLE ankle sprains can be corrected without SURGERY (based on evidence obtained from more than 1500 articles on the Rx for ankle sprain). So, could the unstable ankle sprains be rehabilitated in a FUNCTIONAL protocol (as this article has proven) ??
I have applied local mini-injections of heparin surrounding deep muscle and deep cutaneous lesions with excellent results. No scarring is observed, only regeneration of the original tissues. Can this be transferred to aleviated diabetic neuropathic ischemia in early stages?
Work comp in my area is making some changes to their requirements. One of which is they want providers to monitor pain and function if prescribing opioids. They made a suggestion of a tool to use but I thought I'd ask the community.
Does anyone have a favorite tool to measure and track pain and function? Ideally it would be a simple (for both patient and provider) and cheap tool that I can use that is not diagnosis specific.
The social costs of cares for chronic pain patients is an important aspect, also giving problems to the health care systems. Any suggestion to increasing visibility, with not negative influences on the costs for the national welfare system would be more than welcome.
I have been using these injections in my selective patients with good outcome; I would like to know your thoughts on this
I have a male 60 year old patient who has Psoriatic Arthritis well controlled with 12.5mg of metholtrexate per week. Because of previous crisis' he has a knee replacement, gets painful feet, has o/a elbow and various other bits and bobs. Has a job where he is on feet all day, 8-10 hours.
He does feel he has to supplement with analgesics to get through his day as he has 6 children to support and is self employed....so if he doesn't work he doesn't get paid
On a daily basis he takes an ibuprfene 400mg and a pill containing 500mg of paracetamol and 20mg of codeine 3 times per day for the past 4 years . He seems happy and is able to work productively......without apparent negative side effects. His liver enzymes are only slightly raised. He is not constipated and takes regular extra fiber toward this end. He likes an occasional glass of wine in the evening.
He walks regularly and twice a week has a swim and sauna at his club.
Considering the addictive nature of opioids like codeine should I encourage him to cut down or leave well enough alone as he SEEMS to be doing well?